`Clock Is Ticking'

Experts Plan For The Next Inevitable Influenza Pandemic

November 18, 2004|By GARRET CONDON; Courant Staff Writer

Weary seniors waited hours for supermarket flu shots. The lines snaked around the block and tempers spilled over as vaccine ran low. This year's influenza season is already infamous -- and the flu itself is just beginning to arrive. But the shortages, panic and public health response are a dress rehearsal for a much worse flu season expected sometime in the next several years.

``This is a cakewalk compared to what we'd have'' in a pandemic, said Stephen Morse, director of the Center for Public Health Preparedness at Columbia University's Mailman School of Public Health.

Pandemic flu -- the emergence of a new subtype of influenza A that spreads across the globe -- is a near certainty. Because it will be new, many humans will be susceptible to it. One such pandemic, the ``Spanish flu'' epidemic of 1918-19, was extraordinarily lethal, killing a half-million Americans and nearly 9,000 Connecticut residents. The next two pandemics were not nearly as deadly. The ``Asian flu'' of 1957-58 killed 70,000 Americans, and the ``Hong Kong flu'' pandemic of 1968-69 killed 34,000.

Historians observe that major flu pandemics occur roughly every 30 to 35 years. But there is no way to predict exactly when the next pandemic will arrive, or to foretell its deadliness.

``The pandemic clock is ticking, and we don't know what time it is,'' said Dr. Bruce Gellin, a West Hartford native who is director of the National Vaccine Program Office at the federal Department of Health and Human Services.

Therefore, readiness is all.

Connecticut probably has never been better prepared for pandemic influenza, but this may say as much about past inaction as about present readiness. Dr. Matthew Cartter, the state's epidemiology program coordinator, said that flu pandemic planning was a hard sell among public health and safety officials for many years -- until the terror and anthrax attacks of 2001. This, coupled with the threat of smallpox and last year's appearance of SARS, galvanized the planning process.

The federal government released a draft national pandemic plan over the summer and the state's plan -- now in draft form -- must be made final and submitted to Washington by next summer.

Since 9/11, federal health officials have spent $4.2 billion on state, local and hospital bioterrorism preparedness. More than $49 million has flowed to Connecticut, according to federal figures. Two bioterrorism ``centers of excellence'' have been established at Hartford and Yale-New Haven hospitals, each supervising half of the state. The planning process has brought together police, hospitals, public utility officials, schools, health departments and districts, the military and others. The state's 96 local health departments and districts have been divided into 10 bioterrorism planning regions and 42 vaccination clinic sites have been established to vaccinate the entire state in about 10 days.

The idea is that a rising tide of bioterrorism funds floats all public-health-emergency boats. ``If you build up the public health infrastructure for `How do you distribute smallpox vaccine?' and `What happens with anthrax?' you just plug flu right into that,'' said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

The Vaccine Conundrum

But what if there is little or no vaccine to plug in? Making flu vaccine is difficult and time-consuming under the best of circumstances, as Chiron Corp. found out this year when its 48 million British-made doses were found to be tainted. Even if the pandemic strain is quickly identified and vaccine manufacturing goes smoothly, it will take months to get the millions of doses needed -- months when the flu could be making the rounds.

``We're going to be pretty much stuck with the fact we're going to have next to no vaccine for the first wave of the pandemic,'' said Richard Webby, assistant member of the department of infectious disease at St. Jude Children's Research Hospital in Memphis.

Cartter said that having little or no vaccine in Connecticut will be a huge dilemma. ``That will present us with problems -- not only medical and scientific in nature, but also ethical. ... As a society, we'll have to come to grips with the question of, if there is only so much vaccine, who gets it?''

The draft of the national pandemic plan suggests that the federal government might establish the vaccine A-list, but Gellin said that is merely a starting point for a broad, national discussion about how vaccine should be distributed. ``This is such an important issue, we don't have an answer to it yet,'' he said. ``This is really the first step.''

Public officials will have to weigh protecting the most vulnerable patients against the need to use vaccine to maintain public order and essential functions. Many of the same questions may have to be asked to create priorities for the use of antiviral drugs, which also are likely to be in short supply. This flu season, there are enough antiviral drugs to treat 40 million Americans.